Discharge instructions following

DISCHARGE INSTRUCTIONS FOLLOWING
TOTAL KNEE REPLACEMENT
Stephen J. Kelly, M.D.
This handout includes many of the questions you might have following your discharge to home. If you have other questions, please call the office at 828-2100. If you should have SHORTNESS of BREATH or CHEST PAIN, call 911 or go to the
nearest emergency department (ED)
CALL OUR OFFICE AT 828-2100 IF YOU HAVE ANY OF THE FOLLOWING
 If you have any drainage or redness associated with your wound  If you have a fever greater than 101.5° F° (38.5°C)  If you have persistent calf pain or swelling that does not improve with elevation (putting the leg on two or three pillows bringing it above the level of your heart). Calf pain or swelling could be an indication of a blood clot.  If your pain seems to be worsening  If you have difficulty urinating or if you have symptoms of burning with urination MEDICATIONS
You will be given prescriptions for pain medication. There are three possible medication protocols we will choose from. Take your pain medicine as directed on the instructions. You will be following protocol
Protocol
Oxycodone 5 mg tablets, 1-2 tablets every three to four hours as needed for pain and
Acetaminophen (Tylenol) 325 mg tablets, 2 tablets every four hours Hydromorphone (Dilaudid) 2 mg tablets, 1-2 tablets every three hours as needed and
Acetaminophen (Tylenol) 325 mg, 2 tablets every four hours Vicodin 5/325, 1-2 tablets every four hours as needed for pain (Do NOT take Tylenol with this medication) ANTICOAGULATION
After surgery you will be placed on a blood thinner to prevent blood clots. Most people
are started on Coumadin (warfarin) while they are in the hospital. You will take
Coumadin for ten days following surgery. The home health nurse will draw your blood
about 5 days after surgery to monitor your Coumadin levels.
Once you stop taking the Coumadin (warfarin) you should take one aspirin (325 mg) twice a day until you return to see Dr. Kelly in the office (4 weeks). WOUND CARE
Dr. Kelly does not routinely use staples to close his incisions. Instead, he uses stitches below the skin (subcutaneous). You will see the tips of the sutures at each end of your incision. These stitches do not need to be removed as they will dissolve as the wound heals. The ends of the suture will also dissolve and fall off on their own. If they are bothersome, they can be trimmed at the time of your follow-up visit. Your incision will also be covered with Steri-Strips which should be left in place until they start to peel off on their own. You may shower seven days after surgery. Use a gentle soap and pat (not rub) the surgical site dry. We would prefer that you not soak in a tub until one month after surgery. You may also experience some numbness on either side of your incision. This is normal and is due to the nerve endings being cut when the incision was made at surgery. A sense of numbness may always be there; however, in time it may decrease in severity. PHYSICAL THERAPY
Perform the exercises that were explained to you by the therapists while in the hospital. A therapist will come to your home for two to four weeks to do range of motion exercises with your knee, as well as to teach you additional exercises to do on the days he/she does not come to your home. Following this, we will refer to a physical therapy center near your home to complete your rehabilitation from surgery It is necessary to do these exercises to prevent your knee from becoming stiff, resulting in loss of function of your knee. You may feel some pulling and tightness in your knee during exercise; this is normal, although severe pain should be avoided. You may place all of your weight on your leg. The therapist will instruct you in the use of crutches or a walker for additional support while walking. HOW LONG MUST I WEAR THE WHITE TED STOCKINGS?
TED stockings must be worn for six weeks from the surgery date. They are used to help control swelling and improve circulation of blood back to your heart. TED stockings must be worn during the day and may be removed at nighttime, as long as you put them back on when you wake in the morning. SWELLING
 Swelling is normal after this type of surgery. The swelling may last for six weeks to three months and will gradually decrease.  To reduce swelling, lie flat and elevate the leg on two or three pillows. Do this for 30  To help aid in decreasing swelling, ice should be applied to your leg (using the cryo- cuff) three to four times a day at 20-minute increments. WHEN MAY I DRIVE?
Due to weakness in your leg muscles and the danger of having an accident, we encourage you to not drive a car for four to six weeks after your surgery. You should not drive if you are still taking narcotic pain medicines. When you start to drive; drive only short distances and try to avoid areas of heavy traffic. It is advisable that you not sit for any longer than 30 minutes at a time as this may cause increased swelling. After sitting for 30 minutes you should get up and walk around. WHAT MAY I DO FOR ACTIVITY FOLLOWING SURGERY?
You may walk as much as tolerated, using pain and swelling as your guide. You should limit the number of times you climb stairs, as this may increase your pain and swelling. At four to six weeks after surgery you may slowly increase stair climbing. Swimming and stationary biking are good forms of exercise. When using a stationary bike, you will initially need to make the seat high and the resistance low. Use crutches or a walker for support when walking, and advance to a cane when your therapist advises you it is safe to do so.
WHEN MAY I SWIM?
You may resume swimming at four to six weeks postop. This will be discussed at the time of your four-week follow-up appointment.
HOW LONG WILL I BE OUT OF WORK?
You may usually return to work approximately six to ten weeks after surgery. If you have a sedentary job, you may be able to return sooner. Limitations and precautions in the workplace will be discussed prior to your return to work. WILL I HAVE ANY PERMANENT RESTRICTIONS FOLLOWING KNEE REPLACEMENT?
You should avoid kneelling on the operated knee as this mayl cause pain. Additionally, if you kneel/twist just right when getting up, there is a chance you could dislocate the prosthesis. You should not do high-impact activities such as jumping or running. These types of activities can cause the prosthesis to wear out sooner or become loose. F-275

Source: http://www.orthoassociates.com/_pdfs/kelly275knee.pdf